Comparison between modified wet suction and dry suction technique for endoscopic ultrasound‐guided fine‐needle biopsy in pancreatic solid lesions

Abstract

Background and Aim Although endoscopic ultrasound‐guided fine‐needle biopsy is widely applied, there is no clear consensus on the optimal biopsy technique. We described a modified wet suction technique (MWEST) with the aim to compare the efficacy and safety between MWEST and the dry suction technique (DST). Methods In this prospective, randomized, crossover, single‐blinded study, patients with suspected pancreatic malignancy were randomized to the DST (group A) or MWEST (group B) for the first pass, and the two techniques were performed alternately. The primary outcome was the comparison of specimen adequacy and diagnostic yield between the techniques. Secondary outcomes included the macroscopic visible core length, blood contamination of specimens, and adverse events of both techniques. Results From January 2019 to September 2019, 216 passes were performed in 50 patients. The specimen adequacy was significantly higher in “per‐lesion” (P = 0.026), “per‐pass” (cytology: P = 0.034; histology: P = 0.042), and first‐pass analysis (P = 0.034) for MWEST than for DST. In diagnostic yield, MWEST showed significantly superior histological yield (P = 0.014) and first‐pass analysis (κ: MWEST: 0.743 and DST: 0.519) compared with DST. The median macroscopic visible core lengths were 8 mm (interquartile range: 3.25–15 mm) and 10 mm (interquartile range: 5.25–15 mm) for DST and MWEST, respectively (P = 0.036). Blood contamination was significantly more serious in DST than in MWEST (cytology: P = 0.021; histology: P = 0.042). Conclusions Endoscopic ultrasound‐guided fine‐needle biopsy with MWEST resulted in significantly better quality of specimen, histological, and first‐pass diagnostic yields and comparable safety compared with the DST. MWEST is preferred for endoscopic ultrasound‐guided fine‐needle biopsy in pancreatic solid lesions.

EUS-guided liver biopsy using a modified wet heparin suction technique

“…Six different suction techniques in EUS-LB have been reported: dry suction, slow pull, wet suction, modified wet suction, wet heparin, and dry heparin. [2][3][4][5] Our technique is close to the wet heparin suction technique and the modified one-pass, one-actuation wet suction technique (EUS-MLB) with some differences. 6 In comparison with the wet heparin suction technique, we left the heparin syringe attached to the proximal port of the needle until just prior to liver puncture.…”

The Wet Suction Technique Enhances the Diagnostic Efficacy and Aspirate Quality of EUS-FNA for Solid Lesions

“…Furthermore, fine needle biopsy (FNB) could reach higher yields to improve the diagnostic accuracy in pancreatic lesions in a previous study 19. A prospective single-center trial has shown that the wet suction technique could improve the diagnostic rate in FNB for pancreatic solid lesions, compared with dry suction 14. So, the application of combining wet suction and FNB is needed to further investigate in future.…”

Preclinical models derived from endoscopic ultrasound-guided tissue acquisition for individualized treatment of pancreatic ductal adenocarcinoma

“…Both of the FNA and FNB are used in obtaining specimens for preclinical model creation, but there is no comparison revealed which one is more suitable. In spite of this, EUS-FNB has been reported to require fewer passes to achieve a conclusive diagnosis, and immunohistochemistry was more successfully performed in FNB samples ( 31 , 45 , 46 ). Additionally, some studies comparing whether the two types of needle can obtain adequate specimen for genomic profiling, yield of DNA, and theranostic potential have revealed that EUS-FNB were considerably superior to EUS-FNA in these aspects ( 27 , 47 ).…”

“…( 25 , 26 ) and endoscopic ultrasound-guided fine-needle biopsy [EUS-FNB; including EchoTip ProCore (Cook Medical), SharkCore (Medtronic), Acquire (Boston Scientific), Sono Tip Topgain (MediGlobe), etc.] ( 25 – 28 ), could obtain adequate specimens for diagnosis and personalized treatment ( 27 , 29 – 31 ), with a sensitivity of 86.3–98.4% and a specificity of 100% for the diagnosis of pancreatic malignancy ( 32 ). Furthermore, EUS-TA is generally considered a safe procedure with low morbidity (0.59–0.98%) and mortality (0.02%) rates ( 6 , 33 ).…”